Tuesday, July 18, 2017

Mary Schroeder’s students quickly learn that economists care about more than money.

After earning a PhD in Economics at Emory University in Atlanta, Schroeder joined the college six years ago. She is an assistant professor in the Department of Pharmacy Practice and Science (PPS).

Most colleges of pharmacy don’t employ economists. A few years ago, the University of Iowa College of Pharmacy had three.

Economists are trained to consider “costs” beyond just money – including time, resources, and other factors, Schroeder said. “For example, even though a pill may cost less than a dollar a day financially, a patient may not take it because it tastes bad, or because they are supposed to take it four times a day, or because it always made their stomach hurt. Those are also costs.”

Schroeder is curious about how people — especially older adults — make decisions about medical treatments. She also studies the effects of these treatments on quality of life.

She has collaborated with other faculty members and clinicians to assess treatments for cancer, cardiovascular disease and stroke. Schroeder’s economics background helps her look at clinical data in a unique way.

A trend puzzled and concerned the medical community recently: When a woman finds out she has early-stage cancer in one breast, and then she gets a pre-surgery magnetic resonance imaging (MRI), she is more likely to have the other breast be removed than if she had not gotten the diagnostic test. Fact is, most patients’ chances of developing breast cancer on the other side are very small.

Schroeder’s economic background could not accept the association, because she was taught that diagnostic tests do not by themselves affect treatment decisions. Collaborator Alexandra Thomas, MD, told her that MRIs can be too sensitive, and women with questionable results (in this case, in the likely-healthy breast) are routinely asked to get another MRI in six or so months.

Schroeder had a hunch, which she and Thomas followed by creating their own study.

“It turns out, the moment you tell a woman: ‘We saw something on the MRI. It’s most likely nothing, but come back in six months,’ she’s done,” said Schroeder. “She’ll be much more likely to have surgery on both breasts. It wasn’t the fact that she had an MRI, it was the information found on the MRI.”

Schroeder said projects take off when experts really reach into each other’s worlds. “In the beginning when we were working together, I would ask Alex (Thomas) questions and bring her things that a clinician would never think to ask or notice. My ignorance allowed us to contribute uniquely to the literature and profession.”

Schroeder was born in Taiwan, and moved to Indiana with her graduate student father and the rest of the family at age two. The family moved around, eventually settling in Albuquerque, N.M., during her high school years. She interned at Sandia National Laboratories for seven years in high school and college in the security contractor’s computational and shock physics department.

She received a bachelor’s degree in physics, but longed to have humans be part of the equation.

“In physics, once you know the equation you know where the ball is going to be,” she said. “But with humans, there are so many more dimensions to consider and uncertainty due to differences in preferences. … That was intriguing to me.”

Given all the decisions associated with health and healthcare, Schroeder will have plenty to be intrigued about.